Marylou Sudders was in her downtown Boston office by 6 a.m., as usual, getting ready for a critical day in the ambitious state COVID-19 vaccination program that she runs. It was Feb. 18 and nearly 1 million Massachusetts residents had just become eligible for their shots at the stroke of midnight — the biggest expansion yet — and many were already crowding the state’s website to get an appointment.
But what Sudders hoped would be a triumph turned, by the breakfast hour, into a nightmare. The state’s website software crumpled under the barrage of anxious vaccine-seekers, leaving thousands staring at an image of a four-legged orange octopus and a message that the site had crashed. The social media posts were swift and biting, with some calling it “vax insanity.”
And now it was her job to fix it.
“I think I actually first saw something on social media,” recalled the state’s health secretary this week in an interview with the Globe. “I go immediately into ... what I call operational fix-it mode.”
Sudders, known for her steely determination, had no time for disappointment or hurt feelings. All she could do, she said, was focus on the key questions: What’s the problem? How do you stop it from getting worse, remedy the situation, and then explain it all to the masses?
By the end of the day, the website contractor publicly apologized for its failings and Sudders’ team was reaching out to new companies. Somehow, despite the website’s meltdown, about 60,000 residents managed to reserve appointments that day. And, within a month, the state’s vaccine program had gone from slow and balky to one of the top 10 nationally for vaccines administered per capita.
Governor Charlie Baker, who is usually even-tempered but got so exasperated by the fiasco he said he felt like “my hair’s on fire,” said that the 66-year-old Sudders has been his “center of gravity” throughout a pandemic that so far has claimed the lives of more than 17,000 in Massachusetts.
“She’s the one you want in the foxhole with you when you’re in a situation like this, because she will never, ever quit until whatever it is gets fixed,” he said in an interview with the Globe.
Sudders, tapped by Baker in the early days of the pandemic to direct his COVID-19 Response Command Center, is one of the most powerful leaders in Massachusetts, yet hardly a household name. She is in charge of one of the most ambitious initiatives in state history — rolling out COVID vaccines to millions of people. She shapes strategy and addresses emergencies that seem to crop up daily. It is, for example, her signature on the contracts that established a call center to better manage the mad scramble for appointments.
Along the way, Sudders has stepped on plenty of toes. She was instrumental in the controversial decision to temporarily divert vaccines from hospitals when too many doses were sitting in their freezers instead of going into arms. She’s also an architect of the state’s system of mass vaccination centers, such as one at Gillette Stadium, which quickly hastened the process, but upset local public health officials who said the sites were too difficult for many to reach.
“She has the strength to question authority, whether it’s a health plan executive or a hospital group,” said Andrew Dreyfus, chief executive of Blue Cross Blue Shield of Massachusetts. “She is unafraid and that has served her really well.”
A fastidious planner and tactician, Sudders is also known as an edgy boss who demands excellence and has little patience for those who arrive at meetings unprepared.
“She suffers no fools,” said Jay Youmans, a former senior adviser to the state’s public health commissioner under Sudders until March 2017. “She expects when you walk into the room that you have a thoughtful answer to the questions she has.”
Those who know Sudders well say that she’s as well equipped as anyone to handle the stresses of managing an outbreak that has upended daily life, forcing governments to take one unprecedented step after another. But no public servant has been through a period like this before, and Sudders has had to answer for monumental tragedies, such as why Massachusetts experienced one of the highest nursing home death rates in the country.
“The pandemic has really pushed people to different kinds of places and I think she more than anyone has really been in the hot seat,” said Cathy Costanzo, who has known Sudders for 40 years and is executive director of the Center for Public Representation.
Costanzo’s public interest law firm challenged the health department’s medical guidelines last spring that stipulated who should get lifesaving care, such as ventilators, if hospitals got overwhelmed. Advocates said it discriminated against disabled patients and people of color. The guidelines were revised after an outcry and threat of a lawsuit.
“There is some part of her that really thrives on that [pressure] and another that probably found it unbearably overwhelming,” Costanzo said.
In the early days of the pandemic, Sudders ceded some day-to-day, non-COVID responsibilities to a deputy. But since late summer, aides say, she has resumed directing daily operations at an agency that accounts for roughly half the state’s spending. Its 12 departments — for child protection, mental health services, elder affairs, immigrants, and more — touch the lives of one in four state residents.
The Globe spoke about Sudders with more than a dozen people, including state lawmakers, social service advocates, and former colleagues. Some declined to speak publicly, expressing concern about possible professional repercussions, noting the secretary’s wide reach. Yet even her harshest critics cite her decades-long commitment to improving mental health and social services for the most downtrodden, pushing for insurance parity for physical and mental health treatments, and championing better services for children with mental illness.
“What drives her fundamentally is, she wants to help people,” Baker said.
Baker first met Sudders in the early 1990s, when Sudders was working in the state’s Department of Mental Health and Baker was health secretary, the role she now holds.
Sudders traces her passion for social advocacy to her adolescence in upstate New York. Her mother, who suffered from severe depression, died of cirrhosis of the liver. At 15, Sudders took care of her mother for the last six months of her life.
In an interview, Sudders did not go into detail about her early years, but said simply, “I don’t shy away from the complexity of issues and all of us have our life’s experiences that bring us to those.”
Sudders went on to focus in social service and graduated from Boston University with a bachelor’s degree in psychology and a master’s in social work.
“I consider myself very fortunate to have been able to take my experience, my personal experience of mental illness within my family and to be able to become a social worker by training,” she said.
Sudders quickly became known as a tireless advocate for mental health services and by 1996 rose to commissioner for the state’s Department of Mental Health, which she led for seven years. She went on to lead the Massachusetts Society for the Prevention of Cruelty to Children for nine years.
Just after Baker was elected in 2014, he asked her to be his health secretary.
“I went through the interview process with her to be secretary and made it sound like I was talking to all kinds of other people, but you know, I really, I didn’t have a plan B,” Baker said. “I wanted her.”
And Sudders really wanted the job. She has been known to joke with staff, “‘I told my husband when I took this job I will see him in eight years.’ That’s the way she has viewed this commitment,” said one former colleague who asked to remain anonymous for professional reasons. Sudders is married to Bradley Richardson and the couple lives in Cambridge.
The long hours as health secretary under normal conditions foreshadowed even tougher times to come: a grueling 13 months, and counting, of daily crisis.
During one of the most trying of times, the day the state’s website crashed, Sudders spoke via Zoom to community health center leaders who felt the state was turning its back on their struggles to provide care to many hard-hit communities.
It was a tense session. Leaders told Sudders they lacked basic supplies such as upgraded phone systems and computer software to schedule vaccinations, as well as sufficient protective equipment and staff to administer them.
“We didn’t put any filters on that discussion,” said Michael Curry, president and chief executive of the Massachusetts League of Community Health Centers. Sudders mostly listened and took notes, he said. A few weeks later, he said, she notified the league the state would be sending centers $5.1 million for upgrades.
Lydia Conley, president and chief executive of the Association for Behavioral Healthcare, said Sudders also deserves credit for understanding the need to beef up funding for mental health and addiction treatment services early in the pandemic.
“Lives frankly would have been lost were it not for the financial resources under her leadership,” Conley said. “It’s hard to imagine another leader who would have prioritized behavioral health like the secretary has and clearly brought the governor with her.”
For his part, Baker said he deeply appreciates Sudders’ ability to keep him grounded in reality.
“One of the problems when you get a lot of the governors on the phone, we tend to be a little, um, overly optimistic with one another about how we’re doing,” Baker said. “And so it’s nice to have somebody who can do like real reality checks with her peers around what people are doing, and what really is working and what isn’t.”
It is that sort of reality check that Sudders spoke of in an unguarded moment during a recent Zoom event with students, alumni, and faculty at her alma mater, Boston University.
A person asked if there was one thing Sudders wished she had done differently regarding the vaccine rollout. Sudders noted that many other states had also faced challenges. But then she pointed to the website crash of Feb. 18, when that orange octopus greeted tens of thousands of fuming residents.
“I think in hindsight, we did not do as good a job at being prepared for more and more people registering,” Sudders said.
“Clearly we thought we kicked the tires, and had kicked the tires for a capacity for 500,000 individuals,” Sudders said. “But obviously, as we all know, when it hit the million person mark the system...” she trailed off.
The moderator delicately added, “crashed.”
“There was,” Sudders agreed, “a very public crash.”
Matt Stout and Jeremiah Manion of the Globe staff contributed to this report.